Tulane University (School of Medicine)

Founded in 1834, Tulane University School of Medicine is the 15th oldest medical school in the United States. Today the medical school is but one part of the Tulane University Health Sciences Center, which includes the School of Medicine, the Tulane University Hospital and Clinic, the School of Public Health and Tropical Medicine, the University Health Service, the Tulane Regional Primate Research Center, the U.S.-Japan Biomedical Research Laboratories, and the Tulane/Xavier Center for Bioenvironmental Research. Most components of the Health Sciences Center are located in the heart of historic New Orleans, near to the Vieux Carre (French Quarter), Aquarium of the Americas, the Louisiana Superdome and other major attractions.

Tulane University Health Sciences Center is in the midst of a spectacular renaissance and, as a result, has become a most interesting place to study medicine. While much can be said about the faculty, curriculum, research programs, facilities, and other components of the Health Sciences Center, there can be no doubt that what has made Tulane University School of Medicine special is its student body, arguably the most diverse of all the nation's medical schools. The diversity of students, combined with an open and cooperative faculty, has led to the development of a true academic community, a community in which students learn in a non-hostile environment, with the help of friends and colleagues.

Tulane School of Medicine has an Early Acceptance agreement with Tulane University, Loyola University in New Orleans, Xavier University of New Orleans, and Juniata College (Pennsylvania). While the programs vary from school to school, in general outstanding students may apply to a committee at their home institution for early acceptance into Tulane medical school after their sophomore year in college, if they have completed all required course work for medical school. If the undergraduate committee nominates a student for acceptance, that student's application goes before the Admission Committee at Tulane School of Medicine. If the medical school committee accepts the nomination, the student will receive a letter of acceptance into the medical school that will become valid only after the student has completed undergraduate studies. The intent of the program is to free the student from two years of worry about medical school acceptance and allow for more freedom in designing the undergraduate curriculum during the final two years. Students from these schools may obtain more information from their home institution.

Tulane Rural Medical Education (TRuMEd) program, initiated in 2004 with support of Health Resources and services Administration (HRSA), Federal Training Grant to the Department of Family and Community Medicine, will facilitate students' preparation for a career in rural primary care practice. TRuMEd will identify prospective and new medical students who are most likely to become practitioners that serve a rural and underserved populace and foster their interest in primary care residency training and future rural practice.

Educators and policymakers have long realized that medical education strategies were needed as a vital part of the solution to the rural health care needs of the country. As is widely recognized, Louisiana ranks low in overall health indicators compared to other states. Poor accessibility to and availability of primary care physicians contributes substantially to this poor performance, further exacerbated by the rural nature of Louisiana. Sixty-three percent (40 of 64) of our parishes (counties) are rural, with 32% of the state's population, well above the national average of 24%, living in rural areas.

TRuMEd will target the production of more rural practitioners by addressing key elements identified in similar and successful programs around the country. These elements include: an admissions process that assesses, then encourages the selection of several candidates who are most inclined to practice in rural areas; providing students with advisors and role models to support them during medical school; exploring means for student debt management, including scholarships and loan payback; provision of experiences in rural pre-matriculation preceptorships and preclinical experiences will be made available to qualified students.

The Tulane University School of Medicine, in conjunction with the Graduate School and the School of Public Health and Tropical Medicine, offers combined, or dual, degree programs. Medical students may earn either the MPH, MSPH, MPH&TM or PHD degree while studying for their medical degree.

The School of Medicine offers an outstanding curriculum that is designed to prepare students for any field of medicine they wish to pursue upon graduation. There is an excellent balance between basic and clinical sciences with an emphasis on the attitudes, behaviors and clinical skills necessary to effectively practice medicine.

School of Medicine Medical School Location

School of Medicine Courses

FIRST YEAR

The basic science courses in the first year focus on normal structure and function, while incorporating clinical material to emphasize the application of the basic science knowledge. Lectures are complemented by numerous small group discussions in the form of laboratories, case based discussions, problem based learning, and computer assisted instruction. The basic science courses are complemented by the year long Foundations in Medicine course. This course provides the foundation in the physician/patient relationship and includes medical interviewing, medical ethics, community preceptorships, service learning, preventive medicine, human behavior and the health care system. Through the use of lectures, panel presentations, small group discussions, preceptorships and working with real and standardized patients, the skills, behaviors and values necessary for the physicianÕs relationship with patients and society is emphasized. Elective time is available two afternoons per week beginning in the second semester.

COURSES :

* Medical Histology : Medical Histology is a 5 unit course required of all first year medical students and offered to graduate students. The course material provides a basic knowledge of cell structure and function, the organization of cells into tissues, and the organization of tissues into organs. Structural-functional relationships are emphasized. The teaching format for the course includes lectures, laboratory exercises, small group sessions and clinical correlations.The course is offered in the fall semester and during the summer. The course material during the fall is coordinated with the material presented in Gross Anatomy and Embryology. The summer course is an accelerated course which is offered to incoming first year medical students and students requiring remediation at Tulane and other medical schools.

* Gross Anatomy/Embryology : Gross human morphology is studied in our course of Gross Anatomy. The primary course objectives for students are: (1) to develop a working knowledge and vocabulary of the structure and function of the human body, and (2) to be able to solve clinical problems of altered anatomy. To that end we provide for a whole body dissection, an introduction to radiographic anatomy including x-rays, CTs, and MRIs, Problem Based Learning sessions, small group tutorials, lectures, problem discussion sessions, surgical videos, detailed course objectives, and textual guides.The course is of approximately 180 contact hours during the Fall semester of four months duration. There are both clinicians and anatomists on the course faculty providing for a rich mix of clinical and laboratory experience. The faculty and students of Gross Anatomy are together considered a team to begin the process of producing physicians of the highest quality.

* Foundations of Human Molecular and Cellular Biology : In Foundations of Human Molecular and Cellular Biology students will study clinically important aspects of cellular processes contributing to complex human diseases. The course will be divided into four major topics including Genomics and Gene Expression, Cellular Structure and Function, Signal Transduction, and the Cell Life Cycle. The course will conclude with several lectures designed to integrate the course material with detailed analysis and discussion of specific complex diseases. Each lecture is designed to introduce a clinical situation, present relevant molecular and mechanistic information related to the lecture topic, and provide students with the environment to apply their knowledge of molecular and cellular biology to clinical problem solving. An integrative approach to the molecular and cellular mechanisms of disease will equip students with the necessary knowledge and insight to apply current advances in the basic sciences to clinical medicine.This course will involve approximately 32 contact hours during Block 1 of the Fall semester. In the spirit of a truly integrative approach to the molecular biology of human disease the course will involve a team of basic scientists and clinicians.

* Medical Neuroscience : Medical Neuroscience is a 16 week course in the second semester of the first year curriculum designed to introduce students to the fundamental structure and function of the human nervous system as it pertains to clinical medicine. Human Neuroscience is a rapidly expanding, exciting field which can be expected to bring new insights and treatments by the time the medical students have finished residency training. In this time of rapid technological advance, complex cognitive, language and motor functions can by imaged in the living human brain. Advances in the field of functional neurimaging can be expected to bear on stroke prevention, treatment and rehabilitation. Because a tradition in clinical neurology has been to learn the functional organization of the human brain “stroke by stroke”, the course uses this as a model to teach functional organization and neurological localization.Block 1 of the course emphasizes basic spinal cord, brainstem, and cerebral topography with an emphasis on vascular relations. The goal is to introduce the student to principles of neurological localization following stroke, and to provide a foundation for understanding clinical presentations of spinal cord and brainstem lesions. Block 2 considers large scale organization of the cerebral hemispheres and deficits of language and higher cognitive functions following stroke; motor systems and motor disorders; and neurotransmitter systems and their disorders. Block 3 emphasizes concepts of sensory neural systems and their disorders; control of feeding and homeostasis; and integrated basic/clinical science presentations of selected neurological disorders (e.g., Alzheimer's disease, amyotrophic lateral sclerosis (Lou Gehrig's disease), multiple sclerosis).Class sessions include lecture, laboratory, and problem based learning exercises. Clinical correlation lectures are provided as part of the course course content. Lecture and laboratory sessions are supplemented with web-based materials and computer graphics, 3-D reconstructions and animations for individual student review. Block 1 laboratory sessions are aimed at small group learning of nervous system structure and introducing the student to interpreting CT and MRI images in normal and diseased states. Neural systems laboratories in Blocks 2 and 3 are structured around clinically related problem solving exercises to reinforce and extend the material in Block 1. Problem based learning sessions are aimed at allowing students in small groups to work through a clinical scenario that integrates material learned over much of the course.

* Biochemistry : Biochemistry is a branch of the biomedical sciences that deals with the chemistry of life processes. Our course will emphasize those aspects that are particularly relevant to the biochemistry of human beings. Conceptually, biochemistry can be subdivided into four major areas of study: the chemical nature and structure of the various components of living matter (biological structure), the interactions among these components (metabolism); the storage, expression, and transmission of genetic information (molecular biology); and regulation of the reactions which occur in metabolism and molecular biology. Over the past several years, basic research in biochemistry has revolutionized biomedical science and led to the development of unprecedented advances in diagnostic and therapeutic strategies in clinical medicine. We will examine the biochemical basis of many of these advances in our course.

* Human Physiology : What is Physiology? Physiology is the study of function encompassing all levels of organization - from the molecular level through the whole organism. Physiology utilizes fundamental principles of physics, physical chemistry, and biochemistry to understand the body's regulatory mechanisms. Importantly, physiology is not just a collection of facts but is an ordered analytical process - the same process used by physicians and surgeons to analyze pathophysiology of disease. Our objective is to show you how to think with a physiological perspective, in addition to teaching you the factual components of functional mechanisms.How do we Teach Physiology at Tulane? Lectures, readings, patient oriented problem solving, laboratories, and other interactive sessions provide a comprehensive understanding of physiology and an introduction to pathophysiology. Each lecture begins with a brief clinical problem, which helps integrate the basic physiological mechanisms into the context of disease. The handout accompanying each lecture will also specify the learning objectives for that session. Additionally, clinical correlations and/or patient oriented problems will be presented during each block by faculty members of the clinical departments. Finally, the afternoons (two hours per week per student) will feature small groups in problem-based learning sessions and problem-solving exercises. Please be assured that each and every faculty member teaching in our course is committed to helping you master this material.

* Foundations in Medicine I : The Foundations in Medicine course provides the grounding in the physician-patient relationship that is central to all of medical practice. It includes medical interviewing, medical ethics, community preceptorships, service learning, preventive medicine, human behavior and the healthcare system as well as other topics and issues important for contemporary medicine. The course uses large and small group discussions and extensive field experiences emphasizing patient and community contact. It meets every Tuesday and Thursday afternoon throughout the first year.

SECOND YEAR

The second year emphasizes primarily abnormal structure and function while continuing to build on the clinical skills developed in the Foundations in Medicine course. The basic sciences are taught primarily as yearlong courses in a systems based approach that coordinates pathology, pathophysiology, pharmacology and physical diagnosis. Microbiology is coordinated with both pharmacology and infectious diseases. Clinical reasoning is emphasized throughout the year with continued opportunities for elective time, which can also be used by those students pursuing the combined MD/MPH degree.

COURSES :

* Medical Immunology : Immunology is the study of the immune system and how a host fights infectious diseases and cancer. Medical Immunology is a course that lays the foundations in human immunology to prepare the medical student for clinical application. The teaching format of the course includes lectures and small group discussion groups to work out clinical problems related to immunology. Initially, the course focuses on the players (cells and tissues) in immune responses before delving into the specifics of how antibodies are made and utilized by the immune system to fight disease. Once the student understands the different pieces of the immunology puzzle, we bring it all together to help the student understand how immune responses are induced, how the appropriate cells get to where they are needed, what the cells do once they get there, and how the responses are regulated. The last part of the course is focused on clinical consequences of immune responses, such as allergic responses (hypersensitivity), transplant rejection, autoimmune diseases, immunodeficiency, and intervention (immunoreplacement or gene therapy) to modulate immunity.

* Medical Microbiology : Medical Microbiology is a 6 unit course required of all second year medical students and offered to graduate students. The course material provides a basic knowledge structure and function of bacteria, viruses, and fungi, pathogenesis of these organisms, and the interactions between host and pathogen. The teaching format for the course includes lectures, laboratory exercises, small group sessions and clinical correlations.The course is offered in the spring semester and is coordinated with material in pathology, pharmacology and clinical correlates in infectious disease.

* Mechanisms of Disease: Pathology & Pathophysiology : The Mechanisms of Disease: Pathology & Pathophysiology Course integrates the study of the nature of disease with the functional and structural changes that accompany those disease processes. Students are provided both the knowledge about structural and functional alterations that both cause and are the result of these processes. As a result of this course, students will also achieve greater skill in developing differential diagnoses related to these diseases. This course is organized by body systems and all coursework is coordinated with both the pharmacology and clinical diagnosis courses to unify the concepts and the terminology of the subject matter. The system blocks include: cardiology, pulmonary, renal, hematology, gastroenterology, endocrinology/reproduction, and the central nervous system. The Mechanisms of Disease: Pathology & Pathophysiology Course is taught by faculty from both the Department of Pathology and many of the Clinical Deparments, using many educational methods including lectures, case-based discussions, laboratory sessions, tutorials, and computer-assisted instruction.

* Medical Pharmacology : Our 2nd year medical school course in Medical Pharmacology is designed to prepare the student for the clinical study of therapeutics by providing a knowledge of the manner in which drugs modify biological function. The course includes a systematic study of the effects of drugs on different organ systems and disease processes, the mechanisms by which drugs produce their therapeutic and toxic effects, and the factors influencing their absorption, distribution and biological actions. The course consists of a combination of lectures, laboratories, problem based learning sessions, clinical round tables, and small group discussions. The lecture sequence has been coordinated with the 2nd year courses in Pathology and Pathophysiology and the schedules for these courses have been subdivided into different subject or organ blocks to facilitate learning across disciplines. Learning objectives for each contact hour have been developed and are posted on-line. Defined learning objectives are intended to help assist our students in mastering the content of each session, and for preparing for exams scheduled at the end of each subject block. Interactive self-assessment exams have also been developed, and are posted on this web site a few days prior to each block exam.

* Foundations in Medicine II : The Foundations in Medicine course provides the grounding in the physician-patient relationship that is central to all of medical practice. It includes medical interviewing, medical ethics, community preceptorships, service learning, preventive medicine, human behavior and the healthcare system as well as other topics and issues important for contemporary medicine. Foundation in Medicine II includes normal and abnormal human behavior, growth and development, and the continuation of discussions on ethics, professionalism, and other current healthcare issues begun in the first year course. It meets several afternoons throughout the second year.

* Clinical Diagnosis : The paradox of this course is that it is required for graduation. The theme of the course, however, is that you have free will: you don't have to do anything in life except die. This course doesn't teach you what to think; it teaches you how to think. Specifically, it will teach you how to think like a physician. It will teach you to reason through patient data and make informed choices. After this course, you will be able to say, "I don't have to order that test, I choose to order that test."In order to think like a physician, we will teach you the six domains of clinical reasoning. The course begins with an overview of the clinical reasoning process. Students are taught how to use the history of present illness to generate pre-test probabilities, and how to integrate physical exam and laboratory data to arrive at a conclusion. Throughout the year, you will receive lectures on physical diagnosis topics. You will be able to practice these physical diagnosis skills with standardized patients. You will develop your own style of practicing medicine by spending time with clinical preceptors in their day to day practice of medicine. The course will also help you with your written and oral communication skills. Finally, the course will teach you how to draw upon other physicians clinical experience to augment your own. You will be taught the fundamentals of biostatistics needed to interpret and evaluate the medical literature.The teaching format for the course includes lectures, laboratory exercises, small group sessions and clinical correlations.

* Medical Genetics : Medical Genetics is a roughly 30-hour interdisciplinary course designed to act as an overview of clinical disorders that have a genetic component. It surveys many clinical areas and is organized roughly according to genetic etiology and pathophysiology. An emphasis is given to humanistic and ethical issues pertinent to genetic diseases. Each lecture will teach principles by clinical example and seek to inform about diagnostic techniques, treatments and the natural history of disorders. Clinical patient presentations are offered to reinforce the didactic sessions. Review sessions and quizzes will seek to emphasize important concepts and offer time for expanded discussion.

THIRD AND FOURTH YEARS

The third year is devoted entirely to clinical clerkships enabling the student to participate in the diagnosis and management of patients with an extensive variety of clinical problems. These clerkships are primarily offered at the three major teaching hospitals adjacent to the School of Medicine, the Medical Center of Louisiana at New Orleans (Charity and University Hospitals), Tulane University Hospital and Clinic, and the Veterans Affairs Hospital of New Orleans. Other hospitals and clinics including the Huey P. Long Hospital in Pineville, Louisiana and the Ochsner Foundation Hospital in New Orleans provide additional sites. Ambulatory experiences are part of almost all clerkships and form the foundation for the clerkship in family medicine. The other clerkships include internal medicine, surgery, pediatrics, psychiatry and neurology and obstetrics and gynecology. Visiting students are not permitted to participate in the third year clerkships.

The senior year provides an increased measure of responsibility and prepares students for their roles as first year houseofficers. All students are required to complete a sub-internship in the specialty of their choice. This provides a unique opportunity for students to have the experience of being the primary caregiver for patients in a well-supervised setting. All students are also required to take the senior interdisciplinary rotation, which provides students with the opportunity to evaluate and manage undifferentiated patient who presents in the emergency room, urgent care setting or other traditional ambulatory sites in any field of medicine. For most students, the remaining six months are available as electives. For those students who are completing the degree requirements for the MD/MPH degree, one of these electives must be substituted for the MD/MPH core course. Electives are available in any field of medicine, with many students choosing to use this opportunity for extramural rotations at other medical schools in the United States and Canada. Formal exchange programs exist with the Korolinska Institute in Stockholm, Sweden (pediatrics), Heidelberg, Germany, Madgeberg, Germany and the Keio Medical School in Tokyo, Japan. Participation in these exchange programs requires arrangements through the Office of Student Affairs. Each year, a small number of students also make their own arrangements for elective clerkships in both developed and underdeveloped countries throughout the world.

THIRD & FOURTH YEAR CLINICAL CONTINUUM :

* Family Medicine : The Family Medicine Clerkship is a 6 week clerkship required of all junior students as of July 2000. This experience is focused on community-based ambulatory practice and is based in offices of family physicians. The Department has developed a network of about 150 volunteer preceptors who serve as Tulane Clinical Faculty members, located from Lake Charles across most of central and south Louisiana, into south Mississippi, and into the Florida Panhandle. There are sites in rural and urban settings, with solo practitioners, group practices and military practice sites, and in Family Medicine residencies.The student learns one on one with a primary mentor, focusing on common acute and chronic diseases, undifferentiated complaints, prevention, and the process of primary care - skills and knowledge of great relevance to all students whatever their final choice of specialty. During the Clerkship, students live near the preceptor's office in facilities arranged through and provided by the local community. They adopt their host family physician's schedule and participate in the spectrum of family practice including office care, hospital rounds, the consultation/referral process, medical staff meetings, nursing homes care, and other community activities. Students also have the experience of designing, completing and then presenting a family medicine project to their peers at the completion of the rotation.

Internal Medicine : Theory and Practice of Medicine: The purpose of the Internal Medicine Clerkship is to teach students how to [1] properly collect and report data from patients in both the outpatient and inpatient setting, [2] synthesize this data using their book-knowledge of disease processes and clinical problem solving ability to form a comprehensive differential diagnosis for each clinical problem and, [3] manage patients with appropriate diagnostic and therapeutic plans.Students evaluate new patients, perform complete and thorough history and physical examinations, obtain and interpret essential laboratory tests, and integrate this information into differential diagnoses. Approach to and management of common medical problems is emphasized through bedside teaching and daily morning report conferences. The appropriate cost effective utilization of laboratory tests and procedures, including consideration of possible complications, is stressed. The humanistic, moral, professional and ethical aspects of medicine are an integral part of this program.

Obstetrics and Gynecology : The Obstetrics and Gynecology clerkships provides diverse experiences in women's health in a variety of primary and tertiary health care systems. Our primary goal is to cultivate student interest in the unique aspects of women's healthcare. The department's commitment in training includes providing them with the very best instruction in the technical aspects of the specialty. The department also strives to instill a spirit of compassion for women of all races and economic status.The course curriculum has been adapted from a national curriculum developed by the Association of Professors of Gynecology and Obstetrics (APGO). The eight-week course is divided into two four-week segments: Obstetrics and Gynecology. Clinical training is offered at Tulane University Hospital and Clinic, Tulane-Lakeside Hospital, The Ochsner Foundation Hospital, and Huey P. Long Hospital in Pineville, Louisiana. The clinical experience is supplemented by a series of lectures and small preceptor groups. Students are evaluated on their clinical performance by faculty and residents (50%) and on their fund of knowledge by taking the National Board of Medical Examiners Obstetrics and Gynecology Exam (50%)

Pediatrics : The Pediatric clerkship is a required eight-week course whose primary goals are to foster an interest among students in pursuing a career involving the care of infants, children, and adolescents and to assist each student in acquiring the general knowledge and skills pertaining to the care of children that every physician graduating from Tulane should have. The course curriculum has been adapted from a national curriculum developed by the Council on Medical Student Education in Pediatrics (COMSEP). During the eight-week block, students spend four weeks on an inpatient service, two weeks in a neonatal intensive care unit, and two weeks in an ambulatory care setting. These clinical experiences are supplemented by a series of lectures and small group learning sessions. Students are evaluated on their clinical performance (65%) by qualitative assessments from faculty and residents and on their fund of knowledge (35%) by quantitative assessment on three exams. Clinical Experiences are provided at Tulane University Hospital and Clinic and The Ochsner Foundation Hospital.

Psychiatry/Neurology : The psychiatry clerkship is designed to provide students with basic skills in psychiatric diagnosis and treatment applicable to patients across all specialities, particularly those in primary care practices. Students are assigned to a variety of in-patient and out-patient experiences.In addition, the approach to patient care in a chemical dependency program is observed by all students for two half-days during each block. Each student has an opportunity to observe at least four applications of electroconvulsive therapy (ECT). Attendance is expected at the weekly psychiatry grand rounds presentations and at the three weekly teaching seminars, which address a variety of general psychiatric topics.

Surgery : The General Surgery rotation is primarily an inpatient-based experience designed to familiarize the student with acute and elective surgical decision making processes. However, much of the postoperative management is now performed in the outpatient setting and students will as well be expected to participate in this phase of care as well.A team of surgery house officers and at least one attending surgeon-preceptor will staff each General Surgery service, on which medical students will rotate. These personnel will provide ample opportunities for "on the job" experience relative to the discipline of medicine in general and surgery in particular. Come prepared with the knowledge of surgical procedure, anatomy and patient history. You will be asked to assist with positioning, prepping and possibly draping. If not, once gowned and gloved, stand on the sterile field side of the room.During the course of the General Surgery rotation, you are to keep a concise log of all patients for whom you were given primary responsibility. Specific data to be recorded are: primary diagnosis, whether management occurred on an inpatient or outpatient basis, operation (if any), and complications. Clinical experiences are offered at Tulane University Hospital & Clinic and the Ochsner Foundation Hospital.

Tulane Emergency Medicine : All Tulane students must complete two weeks of Emergency Medicine. This requirement can be satisfied through one of the New Orleans emergency facilities (Tulane University Hospital & Clinic or M. L. C. N. O.) or by completing a two or four week elective at another accredited academic Health Center.

Ambulatory Internal Medicine : All medical students in their clinical years are required to complete a four-week rotation in ambulatory internal medicine. This course, while grounded in office-based medicine, also provides students with the opportunity for evaluation and management of the undifferentiated patient. Students will be assigned to General Internal Medicine clinics as well as Medicine subspecialty clinics; in each setting, the student is expected to interview and examine the patient and establish a diagnosis and plan of care under faculty supervision. This broad exposure to both chronic and acute problems in multiple settings affords experience in appropriate consultation, office emergencies, patient education, and reinforcement of the core curriculum across primary care and subspecialty lines. Problem-based didactic sessions, augments the clinical exposure and provides for reinforcement of the diagnostic and patient management skills essential to clinicians in any field. Students may also have the opportunity to observe exercise stress testing, echocardiography and pulmonary function testing on selected patients. Clinical experiences are available at the New Orleans VAMC, Tulane University Hospital & Clinic, the Ochsner Foundation Clinic, and some community based clinics.

Tulane Radiology : All students are required to complete a two week experience in diagnostic imaging and its role in patient care. Students attend lectures and spend time in several of the imaging areas within the radiology department and interact with the radiologist as the results are interpreted and dictated. This experience offers opportunity to correlate patient clinical presentation and findings with the results from the appropriate diagnostic imaging exam(s).During the two weeks, students are required to complete an assigned programmed text on the principles of chest Roentgenology.This requirement can be met through a 2 or 4 week radiology course at any accredited academic health science center.

Outpatient Surgery : All students are required to complete 2 weeks in the outpatient surgery setting. Two or four week electives at any accredited academic health center that meets the following objectives will also satisfy this requirement. During this time we endeavor to broaden the students experience in evaluating surgical patients and to increase their understanding of the different environments in which surgery is performed. The outpatient surgery component of the surgical clerkship can be accomplished (but is not limited to) any of the following settings:1. Ophthalmology2. Orthopedics3. Urology4. Otolaryngology

Subinternship : Sub-Internships provide the student with experience and preparation for inpatient medical care, similar to that of a first year house officer and can be done in Medicine, Surgery, Pediatrics, Family Medicine, or Obstetrics and Gynecology. When students are performing their Sub-Internship, regardless of department, they should act in all capacities as an intern, albeit with a smaller number of patients and greater supervision.Students can fulfill the requirement to complete their sub-internship at any of the major Tulane affiliated hospitals or at another Academic Health Center with prior approval from the Office of Student Affairs. Students cannot complete this requirement at a community hospital except in Family Medicine.Because of the responsibilities involved in patient care, students are expected to provide appropriate care for patients, even on designated school holidays (e.g. July 4th, Martin Luther King Day, Mardi Gras, etc.). Sub-Internships s hould not be taken during months in which the student is interviewing extensively for residency positions. Students who are present fewer than twenty (20) days will be required to make up the time missed during these excused absences. The student will not receive a grade for the sub-internship until this time is made up. The amount and timing of the make up will be at the discretion of the attending staff and the clerkship office. All anticipated absences must be cleared with the attending physician prior to the rotation.